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Hepatitis C

Hepatitis C is a virus that is transmitted in the blood. It can cause chronic liver disease. Virginia Mason's Liver Center of Excellence in the Digestive Disease Institute is dedicated to progressive and innovative management of liver disorders, including chronic hepatitis B and C. Patients benefit from a clinic dedicated to hepatitis C, and from participating in national clinical trials that use new medications for chronic hepatitis B and C through research protocols.

Symptoms of Hepatitis C

Individuals with chronic hepatitis C may not show signs of symptoms for years. However, when symptoms occur they may include:

Fatigue

Nausea

Skin rashes

Swelling of the ankles

Abdominal distention or swelling due to fluid build-up

Abdominal pain on the right side of the body where the liver is located

Jaundice (yellowing of the skin and eyes)

Dark urine

Diagnosing Hepatitis C

Your liver specialist, or hepatologist, will first perform a medical history and physical exam, and will listen to a description of your symptoms. He or she may suspect hepatitis C based on your signs and symptoms. You may have several tests and procedures to obtain a diagnosis and determine the extent of liver damage, including:

Blood Tests — Blood tests can confirm a diagnosis of active chronic hepatitis C as well as the type (genotype) of virus.

Liver Biopsy — A liver biopsy is performed by injecting a thin needle through your abdominal skin (percutaneously) and into the liver to remove a small sample of liver tissue. The area of the puncture is numbed first with a local anesthetic. A liver biopsy may be helpful in grading and staging the disease.

FibroScan — Patients with chronic hepatitis C are at greater risk for fibrosis or “stiffening” of the liver, which can lead to cirrhosis. In order to monitor the status of your liver consistently and accurately, your provider may refer you for a FibroScan exam. FibroScan is a device similar to an ultrasound that assesses the degree of fibrosis of your liver. A series of annual, non-invasive FibroScan tests may show an increase, decrease or plateauing of liver fibrosis.

The FibroScan exam involves lying on your back, with your right arm raised behind your head. A trained clinician will apply a water-based gel to the skin and place the FibroScan probe on your chest with slight pressure. The exam takes 5-10 minutes, provides immediate results and is a painless and non-invasive alternative to obtaining a liver biopsy.

Although hepatitis C can be very serious, with consistent care and monitoring, most people can manage the disease and lead active, full lives. While in the past it was difficult to treat hepatitis C and the medications available were toxic, it is now possible to cure hepatitis C with safe, all-oral medications.

Treating Hepatitis C

Treatment of hepatitis C can often cure the disease. It will vary depending on the severity of liver damage, the type (genotype) of hepatitis C and other health conditions. Each of six genotypes of hepatitis C virus respond differently to treatment, so your hepatologist will first determine the genotype, in order to guide treatment decisions.

Oral medications, known as direct acting antivirals, directly attack and help kill hepatitis C in the body. They are highly effective in over 90 percent of cases, and are very well tolerated with few side effects. There are now several different options for treatment. The choice of regimen will depend on the genotype, and the duration of treatment depends on prior treatment for hepatitis C as well as stage of liver disease.

Liver Transplant

Patients with chronic hepatitis who have a severely compromised liver (from scarring associated with inflammation) or liver failure may be candidates for a liver transplant. Virginia Mason maintains a close working relationship with the University of Washington (UW) Medical Center for patients who may need a liver transplant.

Dietary and Lifestyle Changes

Your hepatologist will likely recommend lifestyle changes to help you avoid further damage to your liver and to protect others you come in contact with. These recommendations may include:

Avoiding alcoholic beverages — Alcohol is absorbed and metabolized by the liver and can make hepatitis worse.

Avoiding certain medications — Your hepatologist will talk with you about over the counter medications, such as acetaminophen (Tylenol), and prescription drugs that can damage the liver.

Preventing others from contracting hepatitis — Chronic viral hepatitis is an infectious (contagious) disease that is transmitted by blood and bodily fluids. You should take precautions not to infect another individual by practicing these preventive measures:

Cover any bleeding wounds with a bandage

Inform your dentist and any health care workers that you have the virus

Don't donate blood

Don't share razors or toothbrushes

Don't have unprotected sex

Don't use dirty intravenous needles

Leading a healthy life

If you have hepatitis, you can live a longer, healthier life by bringing positive changes into your daily routine. These include getting enough exercise, eating the right foods and getting plenty of rest.